title: Management of acute blunt and penetrating external laryngeal trauma.
abstract: OBJECTIVE
  Improve the care of acute external laryngeal trauma by reviewing controversies and the evolution of treatment.
  
  
  METHODS
  Internet-based search engines, civilian and military databases, and manual search of references from these sources over the past 90 years.
  
  
  METHODS
  Utilizing the above-mentioned sources, electronic and manual searches of primary topics such as laryngeal trauma or injury, emergency tracheotomy, airway trauma, intubation versus tracheotomy, cricothyrotomy, esophageal trauma, and emergent management of airway injuries in civilian and combat zones. Citations were reviewed, selected reports analyzed, and the most relevant articles referenced.
  
  
  RESULTS
  Optimal treatment of acute laryngeal trauma includes early identification of injuries utilizing a directed history and physical examination. Timely management of the wounded airway is essential. The choice of intubation, tracheotomy, or cricothyrotomy must be individualized. Computed tomography (CT) may assist in differentiating patients who can be observed versus those who require surgical exploration. In selected patients, laryngeal electromyography and stroboscopy may also be useful. Surgery should begin with direct laryngoscopy and rigid esophagoscopy to evaluate the hard and soft tissues of the larynx, and to visualize the pharynx and esophagus. Minor endolaryngeal lacerations and abrasions may be observed, whereas more significant injuries require primary closure via a thyrotomy. Laryngeal skeletal fractures should be reduced and fixated. Endolaryngeal stenting is reversed for massive mucosal trauma, comminuted fractures, and traumatic anterior commissure disruption.
  
  
  CONCLUSIONS
  Acute external injury to the larynx is both life threatening and a potential long-term management challenge. Although a rare injury, sufficient experience now exists to recommend specific treatments, and to preserve voice and airway function.
authors.affiliation: New York Head and Neck Institute, Department of Otolaryngology-Head and Neck Surgery, Lenox Hill Hospital of the North Shore Long Island Jewish Health System and New York Medical College, New York, New York, U.S.A.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Schaefer
mesh_terms: D000465:Algorithms; D006801:Humans; D007830:Larynx / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000628:therapy*; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000628:therapy*
keywords: Acute laryngeal trauma; blunt and penetrating neck wounds; laryngoesophageal injury; upper airway injury